Both parties agree to work together in a professional and business-like manner.  The Payer staff must give the Hospital staff full name when asked.  If the Payer Utilization Management/Case Management staff conducts itself in behavior that rude, intimidating, threatening or manipulative, and such behavior is documented by Hospital staff, then the following will occur:
1.    Hospital staff will notify Hospital UM Manager who will then inform Payer’s Medical Director of the incident.  Payer Medical Director will investigate and report back to Hospital UM Manager within three (3) working days of the results of the inquiry.  Both parties will discuss the incident and take appropriate action to prevent further occurrences.  If the incident is egregious, Hospital UM Manager may request that the Payer employee in question be removed from all future contact and business dealings with Hospital staff.
2.    If behavior results in the Hospitals’ failure to comply with the terms of the contract, then the Payer cannot deny payment.
3.    If Hospital UM Manager does not agree with Payer Medical Director’s findings, then Hospital UM Manager will refer the incident to Hospital Administration for review.  Hospital reserves the right to use incident as grounds for breach of contract.